Manufacturers of cigarettes for sale in Canada are required to print one of 16 health warnings on each pack of cigarettes. The requirement came into effect in December 2000. Text health warnings on cigarette packets were first imposed by Canadian law in 1989, at which time there were four messages. In 1994, a new set of eight messages came into effect. These warnings quickly spread around the world, and the Canadian system was adopted in countries such as Australia, Thailand and Poland. The 1994 warnings have inspired legislative proposals in the United States and, most recently, in the European Union. So far only Brazil has followed the Canadian example of including photographs in the health warnings although these are now being considered in Australia, Asia and will be tested in Europe this Autumn.

There has been a lot of research into the effectiveness of different health warnings but there is surprisingly little in this research about the role of the photographs. These studies are all part of an ongoing battle between between the manufacturers and governments or anti-smoking groups. This has particularly focussed on what the health warnings can say; with health departments getting ever more hard hitting messages and the tobacco companies ensuring these messages are labelled as being from the government. There have also been a succession of legal cases about how cigarettes can be branded and the legitimacy of terms such as 'mild' or 'light'.

The focus on the text of these warnings belies the fact the photographs used are hilariously culturally specific. First of all when you do not understand the Portuguese text of the Brazilian warnings it is not that clear what the messages are. What for example does the picture of the man loosening his tie mean? That he is hot? Then one asks who these pictures are addressed to, apparently the younger smoker in Brazil and concerned family members in Canada. Finally there are the cultural clichés. The man in hospital watched over by two doctors seems to have found himself in a Brazilian soap opera. Doctor 1: 'How can I tell him that I love his wife' Doctor 2: 'You can't think about that now, only you can safe his life.' Or the different attitudes to impotency in Canada, where it is a joke (a droopy cigarette) and Brazil where it seems to bring about some kind of existential crisis.

There is widespread agreement that the graphic warnings are more effective and attention grabbing, one report notes the 'emotional content of warning messages, in particular those including message-enhancing pictures', but there is no discussion of how these 'messages' are to be articulated. Strathcylde University's Centre for Tobacco Control were commissioned to study the results of the latest warnings in Europe. They had no idea how photographs for European health warnings would be arrived at; probably through an ad agency they suggested. These pictures would then be put in a library and made available for each national government to choose from.

It will be interesting to see what particular local anxieties the Department of Health chooses to target if these warnings arrive in Northern Ireland next year.